Hong Kong activists now face a choice: stay silent, or flee the city. The world must give them a path to safety



Sipa USA Willie Siau / SOPA Images/Sipa U

Brendan Clift, University of Melbourne

In recent days, the prime ministers of the UK and Australia each declared they are working toward providing safe haven visas for Hong Kong residents. In the US, lawmakers passed a bill that would impose sanctions on businesses and individuals that support China’s efforts to restrict Hong Kong’s autonomy.

The prospect of a shift from rhetoric to action reveals just how dire the situation in China’s world city has become.

July 1 is usually associated with Hong Kong’s annual pro-democracy march. This year, it saw around 370 arrests as protesters clashed with police under the shadow of a brand new national security law.




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Hong Kong police have been cracking down hard on demonstrators for over a year – with Beijing’s blessing – and most of this week’s arrests were possible simply because police had banned the gathering.

But ten arrests were made under the national security law for conduct including the possession of banners advocating Hong Kong independence.

Already, a pro-democracy political party has disbanded and activists are fleeing the city.

What’s in the national security law and how it could be applied

The national security law had been unveiled just hours earlier, its details kept secret until this week. It was imposed on Hong Kong in unprecedented circumstances when Chief Executive Carrie Lam, Beijing’s appointed leader in the city, bypassed the local legislature and promulgated it directly.

The law creates four main offences: secession, subversion, terrorism and collusion with foreign forces to endanger national security.

Hong Kong law already contains some offences of this sort, including treason, a disused colonial relic, and terrorism, tightly defined by statute. The new national security offences are different beasts – procedurally unique and alarmingly broad.

Secession, for example, includes the acts of inciting, assisting, supporting, planning, organising or participating in the separation or change of status of any part of China, not necessarily by force. This is calculated to prevent even the discussion of independence or self-determination for Hong Kong.

More than 300 people were detained at a protest this week and ten were arrested under the new law.
e: Sipa USA Willie Siau/SOPA Images/Sipa U

Collusion includes making requests of or receiving instructions from foreign countries, institutions or organisations to disrupt laws or policies in or impose sanctions against Hong Kong or China.

This is aimed at barring Hong Kongers from lobbying foreign governments or making representations at the United Nations, which many protesters have done in the past year.

The law contains severe penalties: for serious cases, between ten years and life imprisonment. It also overrides other Hong Kong laws. The presumption in favour of bail, for instance, will not apply in national security cases, facilitating indefinite detention of accused persons.

Defendants can be tried in Hong Kong courts, but in a major departure from the city’s long-cherished judicial independence, the chief executive will personally appoint the judges for national security cases.

The chief executive also decides if a trial involves state secrets – a concept defined very broadly in China. In these cases, open justice is abandoned and trials will take place behind closed doors with no jury.

A black Hong Kong flag burning last month during an anti-government demonstration.
Viola Kam/SOPA Images/Sipa USA

While Hong Kong courts can apply the new national security law, the power to interpret it lies with Beijing alone. And in the most serious cases, mainland Chinese courts can assume jurisdiction.

This raises the prospect of political prisoners being swallowed up by China’s legal system, which features no presumption of innocence and nominal human rights guarantees. China also leads the world in executions.

Much of the national security law’s content contradicts fundamental principles of Hong Kong’s common law legal system and the terms of its mini-constitution, the Basic Law.

Even the territory’s justice minister – another unelected political appointee – has admitted the systems are incompatible.




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Why it is deliberately vague

In the typical style of mainland Chinese laws, the national security law is drafted in vague and general terms. This is designed to give maximum flexibility to law enforcement and prosecutors, while provoking maximum fear and compliance among the population.

The government has said calls for independence for Hong Kong, Tibet, Xinjiang and even Taiwan are now illegal, as is the popular protest slogan “liberate Hong Kong; revolution of our times”.

Posting Hong Kong independence stickers can now lead to severe punishments.
Sipa USA Willie Siau / SOPA Images/Sipa U

A Beijing spokesman has said the charge of collusion to “provoke hatred” against the Hong Kong government could be used against people who spread rumours that police beat protesters to death in a notorious subway station clash last year, echoing the infamous mainland Chinese law against “picking quarrels and provoking trouble”.

The law does not appear to be retroactive, but fears that it could be interpreted that way have caused a flurry of online activity as people have deleted social media accounts and posts associating them with past protests.

This is unsurprising given the Hong Kong government’s record of trawling through old social media posts for reasons to bar non-establishment candidates from standing at elections.

Dissent in any form becomes extremely hazardous

Despite the promise of autonomy for Hong Kong, enshrined in a pre-handover treaty with the UK that China claims is now irrelevant, the national security law has escalated the project to “harmonise” the upstart region by coercive means, rather than addressing the root causes of dissatisfaction.

Under the auspices of the new law, the Chinese government will openly establish a security agency, with agents unaccountable under local law, in Hong Kong for the first time. It has also authorised itself in the new law to extend its tendrils further into civil society, with mandates to manage the media, the internet, NGOs and school curricula.

Under the weight of this authoritarian agenda, dissent in any form becomes an extremely hazardous prospect. It is no doubt Beijing’s intention that it will one day be impossible – or better yet, something Hong Kongers would not even contemplate.




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The aim of silencing all opposing voices – including those overseas – is clear from the purported extraterritorial operation of the law.

The international community has condemned Beijing’s actions, but its members have a responsibility to follow words with actions. The least that democratic countries like the US, UK, Australia and others can do is offer a realistic path to safety for the civic-minded Hong Kongers who have stood up to the world’s premier authoritarian power at grave personal risk.

Some 23 years after China achieved its long-held ambition of regaining Hong Kong, it has failed to win hearts and minds and has brought out the big stick. Its promises may have been hollow, but its threats are not.The Conversation

Brendan Clift, Teaching Fellow and PhD candidate, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

China’s push into PNG has been surprisingly slow and ineffective. Why has Beijing found the going so tough?



Peter Parks/Pool/EPA

Ian Kemish, The University of Queensland

Chinese activity in Papua New Guinea was not the only factor behind Australia’s Pacific “Step-Up”. As a former high commissioner to PNG, I know it followed serious deliberations about Australia’s overall strategic imperatives in the region.

But China’s engagement with our nearest neighbour was in the minds of many when Prime Minister Scott Morrison announced the foreign policy initiative in November 2018, pledging to

take our engagement with the region to a new level.

Chinese President Xi Jinping was about to make a state visit to Port Moresby, before joining other world leaders at the APEC Summit there. China had been busy repairing roads and constructing an international conference centre in the PNG capital ahead of the meeting, along with a six-lane highway leading to the parliament.

A Chinese hospital ship had just conducted a well-publicised “humanitarian mission” to PNG. And Prime Minister Peter O’Neill had recently signed up to the Belt and Road Initiative, fuelling concern that PNG’s growing financial exposure to China might be converted to Beijing’s strategic advantage.

Xi Jinping was the first Chinese leader to visit PNG when he arrived for the APEC summit in November 2018.
Mick Tsikas/AAP

Xi then used the opportunity of his state visit to pledge an additional US$300 million in concessional loans to the country.

Several Papua New Guinean friends commented then that none of this activity would be of lasting benefit to the struggling developing country. But it certainly captured public attention, and suggested a renewed strategic intent on China’s behalf to boost its influence in the region.




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Recent setbacks in China’s outreach

Eighteen months later, China is still looking for ways to engage with PNG, motivated by interest in both its abundant natural resources and key strategic location. But these efforts sometimes seem uncoordinated, and Beijing has suffered some significant setbacks.

China has been surprisingly slow to respond at critical moments. For instance, PNG officials became frustrated with bureaucratic stalling in early 2019 as they sought to follow up on Xi’s promised loan, and Australia ultimately stepped in to supply the required A$440 million.

Canberra also outmanoeuvred Huawei’s bid to lay undersea high-speed internet cables to PNG and the neighbouring Solomon Islands.

And this year, China has not sent any meaningful signal of solidarity to PNG since the onset of COVID-19 – just proforma PPE donations. Western institutions like the IMF are instead stepping in with emergency financial assistance but, so far at least, China has been nowhere to be seen.

Anti-Chinese sentiment flares up

The recent experience of China’s Zijin Mining Group points to another constraint – the anti-Chinese sentiment that sometimes lurks below the surface in PNG.

The PNG cabinet decided in April not to renew the gold mining lease held jointly by Zijin and Canada’s Barrick Gold at Porgera in the Highlands region. Prime Minister James Marape announced Porgera would instead transition to national ownership.

A letter from Zijin Chairman Chen Jinghe to Marape was then leaked. Chen warned if Zijin’s investment was not “properly protected”, he was

afraid there will be significant negative impact on the bilateral relations between China and PNG.

This provoked visceral anti-Chinese sentiment and praise for Marape’s stance on social media in PNG. Speculation last week the government was looking to sell the mine to another Chinese group sparked a further wave of anti-Chinese feeling – this time critical of Marape.

The tone of some of these messages brought to mind the violent attacks against Chinese and other Asian small business owners at past moments of economic hardship and local tensions in PNG.

A Chinese store owner taking shelter during anti-Chinese protests in PNG in 2009.
ILYA GRIDNEFF/AAP

Zijin is not the first Chinese resource company to face difficulties in PNG. In 2004, China’s Metallurgical
Construction
Company (MCC) secured the agreement of then-Prime Minister Michael Somare to buy the Ramu nickel mine in Madang province.

The company learned quickly that an agreement with the head of government is not enough. MCC did not plan adequately for engagement with landowners, provincial authorities and environmentalists, and inflamed local tensions by using imported Chinese labour.

MCC spent almost two years in court pitted against these groups, to its substantial cost.




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China is not giving up

PNG can be a hard place to operate. As the Australian government and many businesses and NGOs have found, success requires sustained effort with multiple stakeholders.

Chinese companies are not giving up. China Mobile reportedly looked at taking over domestic mobile carrier Digicel earlier this year, and Shenzhen Energy is persevering with its stalled US$2 billion “Ramu 2” hydro power project, given initial approval by the O’Neill government in 2015.

Industry sources report the current government, eager to announce employment-generating projects, is considering moving to implementation stage after some hesitation.




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A deal has also recently been signed allowing PNG seafood exports to China.

China has every right to pursue investments in the region, and PNG is entitled to diversify its external links. Beijing will likely make further advances, but on current form these will likely be more opportunistic than strategic.

Australia should engage China positively in PNG, consistent with its bilateral interests in both Port Moresby and Beijing. It should also build confidently on the advantages that flow from geographic proximity and a long, overall positive relationship with its friends across the Torres Strait.The Conversation

Ian Kemish, Former Ambassador and Adjunct Professor, School of Historical and Philosophical Inquiry, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Labor likely to win Eden-Monaro; Andrews’s ratings fall in Victoria



Labor’s Kristy McBain Opposition Leader Anthony Albanese.
AAP/Lukas Coch

Adrian Beaumont, University of Melbourne

At Saturday’s Eden-Monaro byelection, Labor’s Kristy McBain currently leads the Liberals’ Fiona Kotvojs by a 50.7-49.3 projected margin in The Poll Bludger’s Eden-Monaro election page. This page has all the numbers, including booth by booth results. The projected margin is an estimate of the margin once all votes are counted, not the current margin. McBain is given a 74% win probability.

Primary vote projections are currently 38.5% Liberal, 35.3% Labor, 6% National, 6% Greens and 14.2% for all Others. Had preference flows at the byelection been similar to the 2019 federal election, the Liberals would have won. But Labor currently has 50% of all preferences, a 10% swing on preference flows to Labor.

While the Greens lost vote share, much of it went to Help End Marijuana Prohibition (HEMP), which won 2.5%. Labor also benefited from the “donkey vote” coming from the Shooters, Fishers and Farmers. The Shooters were first on the ballot paper, with Labor ahead of the Liberals.

If Labor holds on in Eden-Monaro, it will be a huge relief for Anthony Albanese. Analyst Peter Brent wrote in Inside Story that, while no government has gained an opposition-held seat at a byelection in almost a century, the lack of a personal vote for the sitting MP in opposition-held seats means they are far more likely to swing to the government at a byelection than in a government-held seat.

In 2013, the Abbott government achieved a 1.2% two party swing in former PM Kevin Rudd’s seat of Griffith at a byelection. Had that swing occurred Saturday, the Liberals would have gained Eden-Monaro.




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Premiers still have high ratings, but Andrews falls in Victoria

In late April, Newspoll polled the ratings of the six premiers, and this exercise was repeated last week. Samples were 500-550 for the mainland states, and 311 in Tasmania.

Tasmanian Liberal Premier Peter Gutwein had the best ratings in the June premiers’ Newspoll, at 90% satisfied, 8% dissatisfied (net +82). His satisfaction rating overtook WA Labor Premier Mark McGowan in April (89%) as the best ever for a premier or PM in Australian polling history.

Gutwein’s net approval was up nine points from April, while McGowan slid four points to a still very high 88% satisfied, 9% dissatisfied (net +79).

The biggest change in net approval was Victorian Labor Premier Daniel Andrews. His net approval fell 18 points to +40, with 67% satisfied and 27% dissatisfied. Andrews’s fall appears to be related to the recent spike in Victorian coronavirus cases, not the Adem Somyurek branch stacking affair. His net ratings on handling coronavirus fell sharply from +74 to +47.

NSW Liberal Premier Gladys Berejiklian had a +42 net approval, down from +46, with 68% satisfied and 26% dissatisfied. SA Liberal Premier Steven Marshall had a +52 net approval, up from +47, with 72% satisfied and 20% dissatisfied.

Queensland Labor Premier Annastacia Palaszczuk continued to trail with a +24 net approval, though that was up eight points. 59% were satisfied and 35% dissatisfied. The Queensland election will be held in late October.

Scott Morrison had a +41 net approval in last Monday’s federal Newspoll. Palaszczuk trails Morrison, Andrews and Berejiklian are about level, Marshall is above him, and McGowan and Gutwein are far ahead.

A good US jobs report, but there’s a long way to go

The June US jobs report was released Thursday. 4.8 million jobs were created and the unemployment rate dropped 2.2% to 11.1%. While the unemployment rate is far better than the 14.7% in April, it is far worse than during a normal economy.

The employment population ratio – the percentage of eligible Americans that are employed – rose 1.8% in June to 54.6%. But at the lowest point of the recovery from the global financial crisis, the employment ratio was 58.2%.

The surveys used for the jobs report were conducted in mid-June, before the recent spike in US coronavirus cases, which peaked at over 57,000 on Thursday. This new spike may derail an economic recovery.The Conversation

Adrian Beaumont, Honorary Associate, School of Mathematics and Statistics, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The US has bought most of the world’s remdesivir. Here’s what it means for the rest of us



Dimitri Karastelev/Unsplash, CC BY

Barbara Mintzes, University of Sydney and Ellen ‘t Hoen, University of Groningen

To beat the coronavirus pandemic, countries need to collaborate. We need the best possible science to develop vaccines and drugs, and to test, track and contain the virus. If we’ve learned anything from the rapid global spread of this virus, it’s that we’re all in this together.

It was therefore shocking to hear, on June 29, that the US government has bought more than 500,000 treatment courses of the antiviral drug remdesivir, representing manufacturer Gilead’s entire production capacity for the next three months and effectively excluding other countries from accessing this drug.




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The purchase raises concerns, not only about access to remdesivir in other countries, but more broadly about how to prevent profiteering from the COVID-19 pandemic.

Gilead announced its global price for remdesivir on June 29 as US$390 per vial. The Guardian has reported the cost to the US government will be US$3,200 for a six-day treatment. In contrast, production costs for remdesivir are estimated at 93 US cents for one day’s treatment, or less than US$6 for an entire course.

The profit motive

It was hardly a secret that Gilead was seeking to profit from its product. Earlier this year, it applied for seven years of “orphan drug exclusivity” for remdesivir – a status that extends a drug’s period of patent protection, and is meant to act as a regulatory incentive to develop drugs for rare diseases. If only COVID-19 were rare!

The US Food and Drug Administration granted the exclusivity 12 days after the World Health Organisation declared COVID-19 a pandemic. The move was met with strong criticism and Gilead has since rescinded the orphan drug status.

US consumer group Public Citizen estimates taxpayers in the US, Europe and Asia have contributed US$70.5 million in development costs for remdesivir. The list of US government grants is impressive and begs the question of whether remdesivir should be in the public domain. Instead, Gilead maintains a monopoly on sales, holding patents in many countries, the latest of which lasts until 2036.

Remdesivir’s revenue this year could be US$2.3 billion, which would make the drug a blockbuster.

We might criticise Gilead, but this is how commercial drug companies function – in non-pandemic times, at least. But it does call into question pharma’s lofty promises of ensuring “equitable global access” to COVID-19 treatments.




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Is remdesivir worthwhile anyway?

If remdesivir doesn’t work, the US purchase would be a waste of money. The first report of benefit was a small follow-up study of 53 patients with no comparison group. This was followed by a more rigorous randomised controlled trial from China, published in the Lancet, in which remdesivir did not outperform placebo. However, fewer patients were recruited than anticipated.

A third, mainly publicly funded trial by the US National Institute of Allergy and Infectious Diseases found patients given remdesivir recovered four days earlier, on average, than those not treated with the drug. But it also found no statistically significant difference in death rate between the two groups.

That study was also stopped early, which can lead to exaggerated estimates of treatment benefits. A British Medical Journal editorial highlighted the study’s financial links to Gilead as another source of bias.




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More trials are ongoing, but until more evidence becomes available we really don’t know whether remdesivir significantly helps COVID-19 patients. If it does, it would be needed not only in the US but globally. Now Gilead’s supply is confined to the US, what can other countries do?

As a stopgap measure, Gilead has donated a stockpile of remdesivir to Australia, but it’s unclear whether this is a one-time-only act of generosity, or indeed why Gilead would donate its products to a wealthy country like Australia.

Bypass Gilead’s patents?

Gilead has voluntary licence agreements with manufacturers in Egypt, India and Pakistan to supply remdesivir to 127 lower-income countries. Under these agreements, Gilead allows generic manufacturers to produce remdesivir with specified conditions, such as limits on where it can be sold. A company in Bangladesh, where Gilead holds no patents, also produces generic remdesivir.

Where Gilead holds patents, countries could nevertheless gain access to generic remdesivir by issuing a compulsory licence. This is a recognised measure under both international trade law and the patent laws of many countries, including Australia. A compulsory licence grants the right to produce and sell a patented drug without the permission of the patent holder, both domestically and to other countries that have also issued a compulsory licence.

Boost international solidarity

The remdesivir saga highlights the need for greater international solidarity and a more public health-oriented approach to the development of new treatments. On June 1, 2020, the World Health Organisation addressed this by launching the COVID-19 Technology Access Pool (C-TAP), which offers a way to share knowledge and intellectual property in response to COVID-19.

Countries and charities spending billions of dollars on developing new vaccines and drugs should require that technologies developed with public funds are shared with C-TAP.

Unfortunately, Australia has not yet pledged its support to C-TAP. Perhaps the recent experience with remdesivir will help the government realise that an open and collaborative approach is a much-needed alternative to one country hoarding the world’s supply of an overpriced and largely unproven drug.The Conversation

Barbara Mintzes, Senior Lecturer, Faculty of Pharmacy, University of Sydney and Ellen ‘t Hoen, Global Health Law Fellow, University Medical Centre Groningen, University of Groningen

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Alert but not alarmed: what to make of new H1N1 swine flu with ‘pandemic potential’ found in China



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Ian M. Mackay, The University of Queensland

Researchers have found a new strain of flu virus with “pandemic potential” in China that can jump from pigs to humans, triggering a suite of worrying headlines.

It’s excellent this virus has been found early, and raising the alarm quickly allows virologists to swing into action developing new specific tests for this particular flu virus.

But it’s important to understand that, as yet, there is no evidence of human-to-human transmission of this particular virus. And while antibody tests found swine workers in China have had it in the past, there’s no evidence yet that it’s particularly deadly.




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What we know so far

China has a wonderful influenza surveillance system across all its provinces. They keep track of bird, human and swine flus because, as the researchers note in their paper, “systematic surveillance of influenza viruses in pigs is essential for early warning and preparedness for the next potential pandemic.”

In their influenza virus surveillance of pigs from 2011 to 2018, the researchers found what they called “a recently emerged genotype 4 (G4) reassortant Eurasian avian-like (EA) H1N1 virus.” In their paper, they call the virus G4 EA H1N1. It has been ticking over since 2013 and became the majority swine H1N1 virus in China in 2018.

In plain English, they discovered a new flu that’s a mix of our human H1N1 flu and an avian-based flu.

What’s interesting is antibody tests picked up that workers handling swine in these areas have been infected. Among those workers they tested, about 10% (35 people out of 338 tested) showed signs of having had the new G4 EA H1N1 virus in the past. People aged between 18 to 35 years old seemed more likely to have had it.

Of note, though, was that a small percentage of general household blood samples from people who were expected to have had little pig contact were also antibody positive (meaning they had the virus in the past).

Importantly, the researchers found no evidence yet of human-to-human transmission. They did find “efficient infectivity and aerosol transmission in ferrets” – meaning there’s evidence the new virus can spread by aerosol droplets from ferret to ferret (which we often use as surrogates for humans in flu studies). G4-infected ferrets became sick, lost weight and acquired lung damage, just like those infected with one of our seasonal human H1N1 flu strains.

They also found the virus can infect human airway cells. Most humans don’t already have antibodies to the G4 viruses meaning most people’s immune systems don’t have the necessary tools to prevent disease if they get infected by a G4 virus.

In summary, this virus has been around a few years, we know it can jump from pigs to humans and it ticks all the boxes to be what infectious disease scholars call a PPP — a potential pandemic pathogen.

If a human does get this new G4 EA H1N1 virus, how severe is it?

We don’t have much evidence to work with yet but it’s likely people who got these infections in the past didn’t find it too memorable. There’s not a huge amount of detail in the new paper but of the people the researchers sampled, none died from this virus.

There’s no sign this new virus has taken off or spread in the regions of China where it was found. China has excellent virus surveillance systems and right now we don’t need to panic.

The World Health Organisation has said it is keeping a close eye on these developments and “it also highlights that we cannot let down our guard on influenza”.




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What’s next?

People in my field — infectious disease research — are alert but not alarmed. New strains of flu do pop up from time to time and we need to be ready to respond when they do, watching carefully for signs of human-to-human transmission.

As far as I can tell, the specific tests we use for influenza in humans won’t identify this new G4 EA H1N1 virus, so we should design new tests and have them ready. Our general flu A screening test should work though.

In other words, we can tell if someone has what’s called “Influenza A” (one kind of flu virus we usually see in flu season) but that’s a catch-all term, and there are many strains of flu within that category. We don’t yet have a customised test to detect this new particular strain of flu identified in China. But we can make one quickly.

Being prepared at the laboratory level if we see strange upticks in influenza is essential and underscores the importance of pandemic planning, ongoing virus surveillance and comprehensive public health policies.

And as with all flus, our best defences are meticulous hand washing and keeping physical distance from others if you, or they, are at all unwell.The Conversation

Ian M. Mackay, Adjunct assistant professor, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why some people don’t want to take a COVID-19 test


Jane Williams, University of Sydney and Bridget Haire, UNSW

Last week, outgoing chief medical officer Brendan Murphy announced all returned travellers would be tested for COVID-19 before and after quarantine.

Some were surprised testing was not already required. Others were outraged some 30% of returned travellers in hotel quarantine in Victoria had declined to be tested.

This week, Victorian premier Daniel Andrews said more than 900 people in two Melbourne “hotspots” had declined door-to-door testing.

Again, there was outrage. People refusing COVID-19 tests were labelled selfish and rude.

A positive test result, together with contact tracing, gives public health authorities important information about the spread of SARS-CoV-2, the coronavirus that causes COVID-19, in a community.

So why might people at higher risk of a positive result be reluctant testers? And what can we do to improve testing rates?

The many reasons why

Reluctance to be tested for COVID-19 is not unique to returned travellers in hotel quarantine or people living in “hotspot” suburbs.

In the week ending June 28, FluTracking, a voluntary online surveillance system, reported only 46% of people with a fever and cough had gone for a COVID-19 test.

That can be for a variety of reasons.

A medical test result is not a neutral piece of information. People may refuse medical testing (if they have symptoms) or screening (if no symptoms) of any type because they want to avoid the consequences of a positive result.

Alternatively, they might want to avoid the perceived burden of the test procedure itself.

Reasons may relate to potentially losing money or work

Many reasons for avoiding testing are likely to be structural: a casualised workforce means fewer workers with sick leave and a higher burden associated with having to isolate while waiting for test results. After a COVID-19 test in NSW, for instance, this can take 24-72 hours.

Then there’s the issue of precarious work. If people can’t attend work, either waiting at home for test results or recovering from sickness, they may lose their job altogether.




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In the case of hotel quarantine, a positive result on day ten will mean a longer stay in isolation. Hotel quarantine is not an easy experience for many, particularly if quarantining alone.

An extension of time at a point where the end is in sight may be a very difficult proposition to stomach, such that avoiding testing is a preferable option.

Another structural issue is whether governments have done enough to reach linguistically diverse communities with public health advice, which Victoria’s chief health officer Brett Sutton recently admitted may be an issue.

Through no fault of their own, may people who don’t speak English as a first language, in Victoria or elsewhere, may not be getting COVID-19 health advice about symptoms, isolation or testing many of us take for granted.




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People might fear the procedure or live with past traumas

Reasons may be personal and include fear of the test procedure itself (or fear it will hurt their children), distrust in government or public health systems, and worry about the extent of public health department scrutiny a positive result will bring.

People may also feel unprepared and cautious in the case of door-knocking testing campaigns.

We can’t dismiss these concerns as paranoid. Fears of invasive procedures are associated with past trauma, such as sexual abuse.

People who have experienced discrimination and marginalisation may also be less likely to trust governments and health systems.

COVID-19 can also lead to social stigma, including blame and ostracism, even after recovery.

As with any health-related decision, people usually consider, consciously or not, whether benefits outweigh harms. If the benefit of a test is assumed to be low, particularly if symptoms are light or absent, the balance may tip to harms related to discomfort, lost income or diminished freedoms.

Should we force people to get tested?

Although federal and state laws can compel certain people to undergo testing under limited circumstances, acting chief medical officer Paul Kelly said it was “a last resort”.

Forcing a person to undergo a test contravenes that person’s right to bodily integrity. This is the right to make decisions about what happens to your own body, without outside coercion.

It also involves medical personnel having to override their professional responsibility to obtain voluntary and informed consent.

Some states have indicated they will introduce punishments for refusing testing. They include an extension of hotel quarantine and the potential for fines for people not willing to participate in community testing.




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Forced testing will backfire

We don’t think forced testing is the way to go. A heavy-handed approach can create an antagonistic and mistrustful relationship with public health institutions.

The current situation is not the only infectious disease emergency we will face. Removing barriers to participating in public health activities, in the immediate and long term, will enable people to comply with and help build trusted institutions. This is likely to create an enduring public good.

Victoria is trying to make testing easier. It is offering a test that takes a saliva sample rather than a nasal swab, which is widely perceived to be unpleasant.




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This may encourage parents to have their children tested. The test is less sensitive, however, so the gains in increased uptake may be lost in a larger number of false negatives (people who have the virus but test negative).

Ultimately, we need to understand why people refuse testing, and to refine public health approaches to testing that support individuals to make decisions in the public interest.The Conversation

Jane Williams, Researcher at the Centre for Values, Ethics and the Law in Medicine (VELiM), University of Sydney and Bridget Haire, Postdoctoral Research Fellow, Kirby Institute, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Victoria’s coronavirus contact tracers are already under the pump. What happens next?



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Gerard Fitzgerald, Queensland University of Technology

The emergence of significant community transmission of COVID-19 in Melbourne over the past week is greatly concerning to the whole of Australia.

Earlier this week, Victoria’s chief health officer Brett Sutton said the state was struggling to cope with the volume of contact tracing required for more than 2,500 people in self-isolation, who must have all their close contacts traced and contacted:

[…] we’re at the limits of managing that number.

Since then, the number of cases in Victoria has risen further still.

What options are available for increasing the pool of contact tracers in Victoria, or any other state that finds itself handling significant rises in COVID-19 cases?




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Remind me, what are contact tracers?

The key strategy to preventing further community transmission is to identify all cases through extensive testing, isolate people who test positive, and then trace their close contacts.

These contacts require initial testing to see if they are also potential spreaders, but more importantly they need to be isolated and closely monitored. Should they develop symptoms, they also need to be tested.

The process of identification of cases, ensuring isolation and monitoring, identifying contacts and following up each of those requires extensive effort.




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Explainer: what is contact tracing and how does it help limit the coronavirus spread?


Every patient who tests positive needs to be interviewed to identify where they have been during the potentially infective stage of the disease, and who they may have come into contact with.

In some circumstances, this may be limited to family members, while in others it may involve following up others who may have been in the same locations, such as workplaces, restaurants, shops or public transport.

All these people need to be made aware of the risk and followed up. This is challenging in a free society. It requires cooperation from the community. It also requires understanding that some who may be spreading the disease are not aware they are doing so.




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Lockdown returns: how far can coronavirus measures go before they infringe on human rights?


This task is traditionally the role of public health workers — including doctors, nurses and those with specific public health qualifications — called contact tracers.

They are the real heroes of this effort, doing mundane work below the radar to keep the community protected.

In normal circumstances, these staff monitor diseases that are present in the community and identify and follow up notifiable disease such as measles, HIV, hepatitis or tuberculosis.

These public health workers have been working desperately hard for months and now those in Victoria are being asked to step up to the mark again.




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How can we expand the pool of contact tracers?

The public health workforce needs to be expanded rapidly to handle the increased workload. There are several ways to do this, some of which have already been implemented in Victoria.

We could reallocate people from other public health functions, which could immediately provide a ready and well-trained workforce.

But this will impact other vital public health protections, including surveillance of other disease, health promotion, screening, early diagnosis and intervention. Diverting staff from these efforts may also have long-term health consequences.




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Staff could be deployed from other agencies, including the Australian Defence Force.

While readily available and well-disciplined for the task, only some of these people have the necessary expertise to identify cases and trace contacts. Others may need to serve in support roles.

Options include calling in the Australian Defence Force to add to the pool of contact tracers (Department of Defence Australia).

Other states and territories could provide support. However, this may require people to relocate to Victoria with the personal disruption implied, as well as the enhanced risk to them and to their families and communities when they return.

This sharing of public health resources across state borders requires significant national cooperation, which has been evident in other parts of Australia’s COVID-19 response.

Finally, people may be recruited from the pool of partly trained people (public health students). While they may lack the practical skills, they will at least bring theoretical knowledge to perform some targeted tasks with specific training. For instance, they could work with experienced personnel to help maintain records or identify contacts.

We have a lot at stake

This new outbreak in Victoria threatens to overwhelm the system’s public health capacity. If that occurs, we can expect large numbers of deaths to follow. We are not there yet, but this outbreak in Victoria is placing the whole country at risk.

So public health workers need all the help and support the Australian community can provide.The Conversation

Gerard Fitzgerald, Emeritus Professor, School of Public Health, Queensland University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Explainer: what’s the new coronavirus saliva test, and how does it work?


Deborah Williamson, The Peter Doherty Institute for Infection and Immunity; Allen Cheng, Monash University, and Sharon Lewin, The Peter Doherty Institute for Infection and Immunity

A cornerstone of containing the COVID-19 pandemic is widespread testing to identify cases and prevent new outbreaks emerging. This strategy is known as “test, trace and isolate”.

The standard test so far has been the swab test, in which a swab goes up your nose and to the back of your throat.

But an alternative method of specimen collection, using saliva, is being evaluated in Victoria and other parts of the world. It may have some benefits, even though it’s not as accurate.




Read more:
Victoria is on the precipice of an uncontrolled coronavirus outbreak. Will the new measures work?


Saliva testing can reduce risks for health workers

The gold standard for detecting SARS-CoV-2 (the coronavirus that causes COVID-19) is a polymerase chain reaction (PCR). This tests for the genetic material of the virus, and is performed most commonly on a swab taken from the nose and throat, or from sputum (mucus from the lungs) in unwell patients.

In Australia, more than 2.5 million of these tests have been carried out since the start of the pandemic, contributing significantly to the control of the virus.

Although a nasal and throat swab is the preferred specimen for detecting the virus, PCR testing on saliva has recently been suggested as an alternative method. Several studies demonstrate the feasibility of this approach, including one conducted at the Doherty Institute (where the lead author of this article works). It used the existing PCR test, but examined saliva instead of nasal samples.




Read more:
Keep your nose out of it: why saliva tests could offer a better alternative to nasal COVID-19 swabs


The use of saliva has several advantages:

  • it is easier and less uncomfortable to take saliva than a swab

  • it may reduce the risk to health-care workers if they do not need to collect the sample

  • it reduces the consumption of personal protective equipment (PPE) and swabs. This is particularly important in settings where these might be in short supply.

But it’s not as sensitive

However, a recent meta-analysis (not yet peer-reviewed) has shown detection from saliva is less sensitive than a nasal swab, with a lower concentration of virus in saliva compared to swabs. It’s important to remember, though, this data is preliminary and must be treated with caution.

Nonetheless, this means saliva testing is likely to miss some cases of COVID-19. This was also shown in our recent study, which compared saliva and nasal swabs in more than 600 adults presenting to a COVID-19 screening clinic.

Of 39 people who tested positive via nasal swab, 87% were positive on saliva. The amount of virus was less in saliva than in the nasal swab. This most likely explains why testing saliva missed the virus in the other 13% of cases.

The laboratory test itself is the same as the PCR tests conducted on nasal swabs, just using saliva as an alternative specimen type. However, Australian laboratories operate under strict quality frameworks. To use saliva as a diagnostic specimen, each laboratory must verify saliva specimens are acceptably accurate when compared to swabs. This is done by testing a bank of known positive and negative saliva specimens and comparing the results with swabs taken from the same patients.

When could saliva testing be used?

In theory, there are several settings where saliva testing could play a role in the diagnosis of COVID-19. These may include:

  • places with limited staff to collect swabs or where high numbers of tests are required

  • settings where swabs and PPE may be in critically short supply

  • some children and other people for whom a nasal swab is difficult.

The use of saliva testing at a population level has not been done anywhere in the world. However, a pilot study is under way in the United Kingdom to test 14,000 health workers. The US Food and Drug Administration recently issued an emergency approval for a diagnostic test that involves home-collected saliva samples.

In Australia, the Victorian government is also piloting the collection of saliva in limited circumstances, alongside traditional swabbing approaches. This is to evaluate whether saliva collection is a useful approach to further expanding the considerable swab-based community testing occurring in response to the current outbreaks in Melbourne.




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A saliva test may be better than no test at all

Undoubtedly, saliva testing is less sensitive than a nasal swab for COVID-19 detection. But in the midst of a public health crisis, there is a strong argument that, in some instances, a test with moderately reduced sensitivity is better than no test at all.

The use of laboratory testing in these huge volumes as a public health strategy has not been tried for previous infectious diseases outbreaks. This has required a scaling up of laboratory capacity far beyond its usual purpose of diagnosing infection for clinical care. In the current absence of a vaccine, widespread testing for COVID-19 is likely to occur for the foreseeable future, with periods of intense testing required to respond to local outbreaks that will inevitably arise.

In addition to swab-free specimens like saliva, testing innovations include self-collected swabs (which has also been tested in Australia), and the use of batch testing of specimens. These approaches could complement established testing methods and may provide additional back-up for population-level screening to ensure testing is readily available to all who need it.


This article is supported by the Judith Neilson Institute for Journalism and Ideas.The Conversation

Deborah Williamson, Professor of Microbiology, The Peter Doherty Institute for Infection and Immunity; Allen Cheng, Professor in Infectious Diseases Epidemiology, Monash University, and Sharon Lewin, Director, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital and Consultant Physician, Department of Infectious Diseases, Alfred Hospital and Monash University, The Peter Doherty Institute for Infection and Immunity

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Lockdown returns: how far can coronavirus measures go before they infringe on human rights?



DANIEL POCKETT/AAP

Stan Winford, RMIT University

As of this morning, ten “hot spot” postcodes in Melbourne’s suburbs have gone back into Stage 3 coronavirus lockdown.

In these suburbs, stay-at-home restrictions will be enforced by police patrols, “booze bus”-style barriers and random checks in transport corridors. In what Premier Daniel Andrews described as “extraordinary steps”, people moving in and out of these suburbs will be asked by police to identify themselves and provide one of four valid reasons for being out. Otherwise, they could face fines.

It seems likely that ever-more restrictive public health measures will be adopted should the coronavirus outbreak continue to worsen. With measures to protect public health competing with individual rights in what appears to be a zero-sum game, there are legitimate questions about how far the government can go before it reaches the outer limits of the law.




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Compulsory testing

In two suburbs of Melbourne, over 900 people have refused to be tested for coronavirus. The reasons vary, but include people being concerned about having to self-isolate and not understanding the dangers of the virus, as well as privacy reasons.

These refusals aren’t explicitly linked to increased transmission rates, but some disgruntled residents in locked-down suburbs and others have called for compulsory testing.

Existing laws already enable compulsory testing, but they have not yet been used. The March declaration of a human biosecurity emergency under the Biosecurity Act empowers the health minister to issue directions considered necessary to prevent or control the spread of coronavirus.

Under the act, these powers must not be used in a manner that is more restrictive and intrusive than necessary. However, there are few other obvious limits on these powers.

Door-to-door testing is now under way in parts of suburban Melbourne.
James Ross/AAP

The Victoria Public Health and Wellbeing Act 2008 gives the chief health officer the power to compel a person to take a test. To use this power, the officer must believe the person either

is infected with the infectious disease or has been exposed to the infectious disease in circumstances where a person is likely to contract the infectious disease.

Unlike the Commonwealth Biosecurity Act, this power seems constrained to being used as a measure of last resort. The Victorian act refers to the consideration of alternatives and a preference for the

measure which is the least restrictive of the rights of the person.

Such orders could be reviewed or challenged in the courts, but more practical challenges, including the need to have police present when conducting compulsory testing, may explain why this measure has not yet been used.

Quarantine restrictions

In the state of emergency currently in force in Victoria, the chief health officer also has the power to detain or restrict the movement of any person for as long as necessary to eliminate or reduce a serious risk to public health.

The hotel quarantine program relies on this power. While the chief health officer must review the need for the continued detention of people at least once every 24 hours, there are no other obvious limits on this power.

In practice, international travellers entering Victoria receive notices imposing a 14-day quarantine with permission to leave their hotel rooms only for medical care, where it is reasonably necessary for physical or mental health, on compassionate grounds, or if there is an emergency.




Read more:
Explainer: what are the Australian government’s powers to quarantine people in a coronavirus outbreak?


The quarantine program in Victoria has been a clear failure, due to the alleged breaches of public health protocols.

An independent inquiry into the program is being conducted by retired judge Jennifer Coate, and Corrections Victoria will take over supervision of the program from the private security contractors who had been running it.

It is possible the newly appointed authorities – with prior experience managing prisoners – may adopt a more restrictive approach.

People detained under the new regime may find it more difficult, for example, to get permission to leave their rooms for supervised outdoor exercise. If this approach is disproportionate to the health risk, and causes or contributes to a person’s ill health, court action may ensue.

Possible infringements on human rights

Public authorities responsible for the management of people in quarantine must balance their role mitigating public health risks with their duty to protect the human rights of those in their care and custody.

In a civil society, fundamental freedoms and individual liberties are highly valued, and intrusive powers should be used only where necessary. In a state of emergency, some limitations of rights may be necessary, but any such limitation must be necessary, justifiable, proportionate and time-bound.

Unless it is overridden by parliament, the Victorian Charter of Human Rights and Responsibilities Act 2006 continues to apply during a state of emergency. Although no charter rights are absolute, this act has been used successfully by people challenging the conditions of their detention.

Governments across Australia have extraordinary emergency powers at their disposal, and have been prepared to use many of them in response to the pandemic. Although the courts have considered the impact of coronavirus on existing laws and procedures – such as the right to protest in the face of social-distancing measures and increased risks to the health of prisoners – they have yet to scrutinise some of the key public health measures adopted.

Despite the deference of courts to public health measures in the face of a deadly infectious disease, there are limits, and it seems inevitable that some limits will eventually be reached.

Returning overseas travellers have been forced to quarantine in hotels since early in the pandemic.
Scott Barbour/AAP

Questions over legitimacy

There are also limits to the effectiveness of these measures when people perceive them as unfair.

People obey laws and comply with rules when they see them as legitimate, not because they fear punishment. If the rules are unclear, or the process of developing them poorly explained, they may feel like postcode lottery to residents. This, in turn, could bring more dissatisfaction with lockdown measures and fail to effect behaviour change.

During times of emergency, it is critical powers with the potential to limit human rights and deprive people of liberty are properly communicated to the community and used with restraint.

This is not only important for the protection of individual rights, but also to prevent lasting damage to the rule of law. Ensuring that respect for human rights remains a central concern of government responses to the pandemic will build confidence and resilience in our communities and our institutions as we emerge from the crisis.




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The Conversation


Stan Winford, Associate Director, Centre for Innovative Justice, RMIT University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Eden-Monaro focus groups: Voters want government to cushion pandemic recovery path


Michelle Grattan, University of Canberra

Eden-Monaro voters are calling for a compassionate and empathetic recovery process as Australia emerges from the pandemic.

In focus group research conducted this week, ahead of Saturday’s byelection, the vast majority of participants favoured increasing the JobSeeker payment above the pre-COVID level, extending the JobKeeper wage subsidy scheme, and providing targeted help for areas hit hard by the summer fires and the impact of the coronavirus.

More surprising, almost all participants were willing to pay more tax to assist the economic and social recovery effort. Many were concerned about leaving debt for future generations.

This was the second round of online research by the University of Canberra’s Mark Evans and Max Halupka. Two groups, with 10 and nine participants respectively, were held on Monday and Tuesday. All but three participants had taken part in the research’s first round. Drawn widely from the diverse electorate, participants included aligned and swinging voters.

Focus group research taps into voters’ attitudes rather than being predictive of the outcome.

Both Scott Morrison and Anthony Albanese have been very active in the seat as voting day nears, although over the campaign as a whole Albanese has been on the ground much more than the PM. But the Liberals have invested heavily in an effort to wrest the seat – which is on a margin of under 1% – from Labor and increase the government’s parliamentary majority.

There was only marginal change in participants’ views on the key issues.

Top issues are: action on climate change, the federal government’s response to the bushfire crisis, job creation, better access to public health care, and addressing the high cost of living.

Climate change action continued to receive the greatest support when people were asked to nominate the one most important issue to them. Most participants saw a link between the bushfire crisis and the need for climate action.

People continued to be aggrieved at the Morrison government’s handling of the fire crisis, which they thought suffered from poor federal leadership, inadequate preparation and insufficient collaboration between federal and state government.

In the second round discussion, there was greater concern over economic recovery issues. “The economy looks weak so we will need good economic management and that tends to come from the Coalition,” a retired Coalition voter noted.

But there was some cynicism over the extra support the government has promised.

People saw Morrison’s announcement in Bega of a $86 million package for the forestry industry, wine producers and apple growers hit by the bushfires as “guilt money”. “It’s an obvious bribe – which might well work,” said a middle-aged hard Coalition supporter, while a female Greens voter described it as “a shameful example of logrolling”.

Most participants thought there would still be a bushfire backlash against the Coalition, despite Morrison’s announcement.

The government is hoping Morrison’s performance on the pandemic negates criticism of his handling of the fires.

Since their first discussion, people have cooled in their views of leaders’ management of the virus crisis. Morrison is now seen as the best performer, followed by NSW premier Gladys Berejiklian, a reversal from the first round.

Berejiklian’s poorer performance is attributed to general annoyance with the states and the perception they are acting “selfishly”. The vast majority of participants think Morrison “is handling the coronavirus outbreak competently and efficiently.” But people are worried by a second wave and cautious about re-opening too quickly.

Albanese is a distant third (the question about him was whether he was doing a good job holding the PM to account); his performance was rated more poorly in the second discussion compared with the first. He wasn’t impacting on the core political agenda: “he hasn’t got a plan,” said one participant.

The vast majority of participants, however, did not believe any party was offering a clear COVID-19 recovery plan and were surprised there hadn’t been a national conversation on the issue.

COVID-19 has constrained the usual forms of campaigning, and has led to a very high demand for postal votes. Participants perceived the Coalition had run a very traditional campaign using “old media”, while they thought Labor had run a “new media” campaign with more emphasis on social media platforms.

Both the major candidates are seen positively. Fiona Kotvojs (Liberal) was considered an “excellent” candidate even by Labor supporters. But several people suggested the intervention of senior Coalition figures in the campaign (Morrison and Payne) may have “reduced her community standing”. Labor’s Kristy McBain was considered a “really hard working” and a “very well liked” candidate by Coalition supporters.

But McBain was regarded as having run the better campaign.

When people were asked who they would vote for, the responses suggested a Labor victory and strong support for McBain. However there had been some attitudinal changes over the campaign.

There appeared to be a marginal increase in support for Cathy Griff (Greens) as the campaign neared its end and two independent candidates emerged from the woodwork – Narelle Storey (Christian Democratic Party) and Matthew Stadtmiller (Shooters, Fishers and Farmers) – during the discussion. That suggested the possibility certain soft Coalition voters might be exercising a protest vote against the government.

Some soft Coalition and Green voters might have moved to Labor and some soft Coalition voters to the Greens, but hard Coalition, Green and Labor voters looked to be remaining loyal.

Kotvojs’s well-resourced campaign appeared to be losing some momentum. But the participants continued to think the election – a straight Labor-Liberal battle despite a field of 14 candidates – would be very close.

This is a byelection where even seasoned watchers are wary of chancing their arm in advance of Saturday night.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.